Pet Owner's Name
If an alternate number is listed above, please indicate where we will reach you at this number (Work, home, etc)
I grant to Ebenezer Animal Hospital,
its representatives and employees, the right to take
photographs of me and/or my pet, and to use and publish the same in print and/or electronically.
I agree that Ebenezer Animal Hospital
may use such photographs of my pet and/or me with
or without my name and for any lawful purpose,
including, for example, such purposes as publicity,
illustration, social media, advertising, and Web content.